Organization
CODAC INC
Active
Other names
Codac Providence
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALISHA M BOURDEAU BS (CFO)
(401) 275-5038
Entity
Organization
Contact information
Practice address
349 HUNTINGTON AVE, CODAC PROVIDENCE, PROVIDENCE, RI 02909
(401) 942-1450
(401) 946-1550
Mailing address
1052 PARK AVE, CRANSTON, RI 02910
(401) 275-5038
(401) 942-3590
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
ACF01632
RI
251K00000X
Public Health or Welfare Agency
605.5
RI
261QM2800X
Methadone Clinic
Primary
605.05
RI
261QM2800X
Methadone Clinic
605.5
RI
261QP2300X
Primary Care Clinic/Center
ACF01632
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
605.05
RI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
605.5
RI
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
605.5
RI
Other
Enumeration date
04/18/2007
Last updated
12/21/2021
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